Los Angeles County looks at how to handle mentally ill inmates in jails

An inmate on suicide watch, dressed in a gown, is lead back to his cell in the Twin Towers. The special gowns are made to prevent inmates from using them to harm themselves. With Los Angeles County facing the prospect of spending as much as $1.7 billion -- and maybe even more -- to tear down and replace notorious Men's Central Jail, advocates for mentally ill inmates are asking the Board of Supervisors to consider so-called diversion programs to reduce costs and recidivism. Los Angeles, CA. 5/27/2014(Photo by John McCoy / Los Angeles Daily News)

An inmate reads while sitting on his bunk in the Mens Central Jail. With Los Angeles County facing the prospect of spending as much as $1.7 billion -- and maybe even more -- to tear down and replace notorious Men's Central Jail, advocates for mentally ill inmates are asking the Board of Supervisors to consider so-called diversion programs to reduce costs and recidivism. Los Angeles, CA. 5/27/2014(Photo by John McCoy / Los Angeles Daily News)

One of the high-observation cells at the Twin Towers Correctional Facility was covered in gibberish — an inmate tormented by mental illness had torn up the brown bag that contained his lunch, fashioned strips of paper into letters, and then stuck them onto the walls, possibly with his saliva.

In another cell, an inmate who seemed to be hearing voices paced back and forth, muttering to himself. Still, he seemed better off than an inmate a few doors down whose cell had a sign that read “suicidal.”

The downtown Los Angeles lockup reeked of disinfectant but sheriff’s Lt. Mike Burse said that was “better than the alternative.” Pressed to explain, he said inmates often defecate on themselves.

Of the 19,000 men and women locked up in Los Angeles County’s jails, about 3,700 — or one out of every five — has been diagnosed with a mental illness. That’s more than enough to fill all the beds at County-USC Medical Center six times over.

A 2011 report commissioned by the county Board of Supervisors from the Vera Institute of Justice, a nonprofit think tank with a Los Angeles office, found the vast majority of the mentally ill in the county jail system were there because they were charged with drug possession, possibly because they “self-medicate,” and quality-of-life crimes like sleeping on the sidewalk.

“We’re locking up sick people and that, to me, seems unjust,” District Attorney Jackie Lacey said in an interview.

Seeking to improve the treatment of mentally ill inmates — and avoid getting sued over existing conditions — the board recently moved closer to approving a $1.7-billion proposal to demolish Men’s Central Jail, across the street from Twin Towers near Union Station, and build a Consolidated Correctional Treatment Facility in its place.

Vanir Construction Management, which came up with the design, envisioned “a treatment facility for inmates instead of a jail providing healthcare.” It recommended 3,700 beds for inmates with mental illness and substance abuse disorders and 1,000 for inmates considered medically fragile or high-security. The annual operating cost was estimated at $350 million a year — that’s on top of demolition and construction costs and interest payments.

Lacey balked at the expense, saying, “Would you like to pay more taxes? Because I think I’m all tapped out.” She urged the county to consider alternatives to incarceration, and convened a summit on diversion programs for the mentally ill.

“There are hardened criminals who give you reason to lock your doors at night, and then there are those with undiagnosed or untreated mental illness whose delusions and paranoia cause them to, say, resist arrest,” Lacey added. “I understand they need supervision but we have to find a way besides a felony conviction.”

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Jails across the county started filling up with the mentally ill in 1955, when the social experiment called psychiatric deinstitutionalization prompted the closure of state-operated asylums over several decades.

American Civil Liberties Union of Southern California Legal Director Peter Eliasberg warned that putting people with schizophrenia, bipolar disorder, major depression and other forms of mental illness behind bars for extended periods can exacerbate their condition.

“They tend to come out worse than when they came in,” he said, because of medication interruptions, post-traumatic stress from being locked up, and physical and/or sexual abuse from fellow inmates and even deputies.

Some inmates don’t come out alive. Last month, the U.S. Justice Department accused the county of continuing to “violate the constitutional rights of prisoners with mental illness,” noting 15 of them committed suicide over the last 30 months. Assistant Sheriff for Custody Terri McDonald and county Mental Health Director Marvin Southard agree jail should not be a “de facto mental hospital” and both are working to expand existing diversion programs, and add more.

“I think the team recognizes the need to do something different,” McDonald said, adding she is assembling a team that would help mentally ill inmates apply for benefits under the Affordable Care Act and Medi-Cal, so they can receive treatment at a community facility rather than jail.

Southard, meanwhile, is sending mental health professionals out on the field to accompany law enforcement officers responding to 9-1-1 calls about potentially crazy behavior. If they conclude someone is mentally ill, they can divert him or her to a community facility.

Recently, Southard secured state funding that would provide about 600 beds in community centers for mentally ill patients undergoing crisis, as well as additional urgent care facilities and triage workers. He is also trying to tap resources provided by the Affordable Care Act.

“I think that will be a game changer for all of us,” Southard said.

Diversion in other states

There are robust diversion programs across the country, and one of the most successful has been that of Miami/Dade County in Florida, developed by Judge Steven Leifman. “We actually closed one of our local jails last year because of the success of the program,” he said by phone. “That saved the county over $12 million a year.”

Called the Criminal Mental Health Project, Miami/Dade County’s diversion program involves training police officers and 9-1-1 operators to spot the signs of mental illness, and providing access to medical treatment, rehab, housing, and other services for those accused of minor crimes. It has allowed 16,000 to 19,000 people to be diverted from jail every year, some of whom have been able to turn their lives around.

“One man with schizoaffective disorder and a crack addiction has now been clean and sober for six years, is married with a baby, and works for the court – it’s amazing,” Leifman said. “We’ve been at it for 14 years and we’re not aware of any horrible outcomes — we’ve had no one in the program go out and commit murder.”

The diversion program in Shelby County, Tennessee, is called the Jericho Project. Shelby County Public Defender Steven Bush, who founded the program, said it “improves safety for everybody, both for the community and the individual who’s placed on the road to recovery.”

He noted the recidivism rate — the rate of re-arrest — among the seriously mentally ill is about 80 percent. For Jericho Project’s that number is slashed in half.

Shelby County Assistant Public Defender Josh Spickler explained the project provides four months of intensive case management and “community linkages” for about 100 mentally ill people a year who are charged with minor crimes, and then keeps them on track with years of probation.

He acknowledged the difference in size between Shelby and Los Angeles counties’ jail populations but said, “I think the encouragement from a place like Shelby County would be: just start.”

“Absolutely the scale is daunting but carve out whatever you can,” he said. “The problem of undiagnosed and unmedicated and unsupported mental illness and addiction is not a criminal justice problem and yet, for so long, we’ve treated it as such.”

“Building a $1.7-billion jail with mental health components is not the solution.”